Drug Interaction: There have been reports of an increase in the effect of the blood thinner, warfarin (Coumadin), by rabeprazole which theoretically could lead to increased bleeding. Patients taking warfarin should be monitored more frequently if they begin taking rabeprazole. Rabeprazole may reduce the elimination of cyclosporin in the liver, thereby increasing cyclosporin levels in the blood and potentially leading to cyclosporin toxicity. The absorption of certain drugs may be affected by changes in stomach acidity. Rabeprazole and other PPIs that reduce stomach acid reduce the absorption and concentration in blood ofketoconazole (Nizoral) and increase the absorption and concentration in blood of digoxin (Lanoxin). This may lead to reduced effectiveness of ketoconazole or increased digoxin toxicity, respectively. PPIs may decrease blood levels of atazanavir (Reyataz).

Mechanism of Action: Rabeprazole is an oral drug that is used for the treatment of conditions caused by acid. It is in a class of drugs called proton pump inhibitors or PPIs which block the production of acid by the stomach. Other drugs in the same class include lansoprazole (Prevacid),omeprazole (Prilosec), pantoprazole (Protonix), esomeprazole (Nexium), and dexlansoprazole (Dexilant). PPIs are used for the treatment of acid-caused conditions such as stomach and duodenal ulcers, gastroesophageal reflux disease (GERD) and Zollinger-Ellison Syndrome. Rabeprazole, like other PPIs, blocks the pump in the wall of the stomach that secretes acid into the stomach. By blocking the pump, the secretion of acid into the stomach is decreased, and this allows ulcers in the stomach and esophagus to heal. The FDA approved rabeprazole in August 1999.

Pregnancy Impact: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Impact During Lactation: Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.

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